Music program hits the right note

James Baldwin reports on a community services program that is supporting carers and people with dementia through the use of personalised MP3 music players

A community services program being run by Southern Cross Care in Victoria is helping people living with dementia relax with their favourite music, stored on an MP3 player. The MP3 player program offers digital music players with personalised playlists. The devices are inexpensive and easy-to-use, and small enough for people to wear during their day-to-day activities. Anecdotally, the program has shown a reduction in agitation and anxiety for people living with dementia, and improved quality of life for them and their carers.

Personalised MP3 players

The MP3 player program, run by Southern Cross Care (Victoria)’s (SCC Vic) Dementia Consultant, Ben Gatehouse, focuses on people’s individual musical preferences. The aim is to help reduce agitated or distressed behaviours. An MP3 player and headphones allows each person to listen to their favourite tracks without interruption, as the tracks can be repeated or looped as required. A major benefit of an MP3 player is its size: these days, digital music players as small as a tie clip can hold hundreds of songs and are easily clipped to clothing while the person with dementia does other activities, such as gardening or exercising. MP3 players (and the music) are purchased on behalf of clients/residents through SCC (Vic)’s ‘Imagine’ Fund.

The ‘Imagine’ Fund was established to ensure that the organisation’s clients, especially financially disadvantaged families, have access to services like the MP3 player program. Ben and the staff at SCC (Vic) have amassed a music library which holds a growing collection of songs in MP3 format. Specific tracks can also be easily sourced and downloaded from the internet. Unlike many traditional music programs, the focus is on enjoyment rather than getting residents or clients to participate with others or listen to a pre-determined set of tracks: instead, a playlist is developed in consultation with the person and their carers or family.

Relaxation through music

Ben came from SCC to assist Debbi Napper, then the primary carer of her late husband, Bruce, who had advanced Alzheimer’s disease. Bruce was exhibiting anxious behaviour and they were looking for ways to help him settle and feel safe and calm. Like many people with Alzheimer’s, Bruce was often physically restless. Debbi was being constantly ‘shadowed’ by her husband around the house: he would follow her into the kitchen while she was cooking, and more problematically, while she was mowing the lawn. The mower would often throw up stones, and because her husband would follow behind her quite closely, she was concerned about the risk of injury.

“As the Alzheimer’s progressed, he would follow me,” Debbi said. “When I tried to do things at home, I had to work around his sleep patterns. Those were very erratic, and he’d get up … sometimes around seven times a night. Sometimes there was nothing I could do at all.”

Debbi and Ben wanted to reduce Bruce’s stress, and Debbi also wished to find activities that would help relieve her own stress. The goal was to find relaxing activities that would improve her husband’s quality of life and reduce his anxiety, while at the same time encouraging him to remain mobile and continue to enjoy life. The couple shared a love of music, especially classical music, and many songs held special significance for them both. Ben had the idea of providing Debbi’s husband with an MP3 player to see if it reduced his anxiety.

Bruce Napper and his wife and carer Debbi

The results were positive, and Bruce calmed significantly with the addition of the MP3 player to his life. His shadowing decreased, as did his anxiety. Doctor’s appointments also became less stressful, as the music would keep Bruce engaged while they waited. Debbi found that with music playing, Bruce was happy to sit by the garden window indoors and not follow close behind the lawn mower. “He was so agitated, with leg movements and jumping up and down from the chair all the time, if I gave him the MP3 player, he could just relax … it calmed him.”

Based on this single success, Ben decided to informally trial the project with other SCC clients living with dementia at home. He observed the same benefits for these clients when the MP3 player was used: anxiety and restlessness were reduced; people listening to their favourite music seemed to experience less agitation. The MP3 player does have its limitations, however: Debbi noted that the music intervention was only effective if it was offered before Bruce’s episodes of agitation became severe.

Partnership with La Trobe University

After informally observing the effect that listening to music had on people living with dementia, Ben wanted to see if his observations held up under objective research. SCC (Vic) established a partnership with the Australian Centre for Evidence-Based Aged Care at La Trobe University in Melbourne to evaluate the impact of the program on the carers of people living with dementia. Data is being collected by questionnaire, and participants include 50 carers of SCC (Vic)’s community clients living with moderate and advanced dementia. One pre-trial and one post-trial questionnaire, completed by the primary carer, contained questions about how and when the MP3 player is used and if its use translated to a change in agitated or anxious behaviours. However the research focus centres primarily on the effect the program has on carers’ mental and physical health and their overall quality of life.

The research project began in August 2012, with 20 of the required participants enrolled. Ben and the La Trobe researchers hoped to complete the study in early January, with results to follow later this year.

Tune of the future

Ben considers an MP3 player as a part of a ‘carer’s toolbox’ rather than a one-size-fits-all solution to a complex issue. Ben said the MP3 program worked best when the music was part of a wider variety of activities, and believes it could be an effective alternative to the use of medication to reduce behavioural problems. “There are always alternative strategies [to consider] before the introduction of psychotropic medication.”

Ben Gatehouse is a consultant who has worked with Southern Cross Care (Vic) for six years, designing, advising and running programs of engagement for people living with dementia. He can be contacted at: bgatehouse@southern-cross.org.au

The AJDC would like to especially thank Debbi Napper for her interview contribution.

James Baldwin is Contributing Editor of the Australian Journal of DementiaCare. Contact him at jbaldwin@uow.edu.au

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